hospital_name last_updated_on version hospital_location hospital_address license_number|MI "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "The Pavilion at HealthPark, LLC" 5/31/2024 2.0.0 "Fort Myers, Florida" 9241 Park Royal Drive license_4507 | FL TRUE description code|1 code|1|type setting drug_unit_of_measurement drug_type_of_measurement standard_charge | gross standard_charge|discounted_cash modifiers standard_charge|payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL standard_charge|payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL |methodology additional_payer_notes |payer_1199 SEIU BENEFIT FUND |plan_COMMERCIAL standard_charge|payer_AARP COMPLETE / UHC |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_AARP COMPLETE / UHC |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_AARP COMPLETE / UHC |plan_MANAGED MEDICARE |negotiated_algorithm 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BENEFIT ADMINISTRATOR |plan_COMMERCIAL standard_charge|payer_KEY BENEFIT ADMINISTRATOR |plan_COMMERCIAL |methodology additional_payer_notes |payer_KEY BENEFIT ADMINISTRATOR |plan_COMMERCIAL standard_charge|payer_LEON HEALTH INC |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_LEON HEALTH INC |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_LEON HEALTH INC |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_LEON HEALTH INC |plan_MANAGED MEDICARE standard_charge|payer_LEON HEALTH INC |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_LEON HEALTH INC |plan_MANAGED MEDICARE standard_charge|payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE standard_charge|payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_LMC HEALTH PLAN |plan_MANAGED MEDICARE standard_charge|payer_LMHBED CONTRACT |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_LMHBED CONTRACT |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_LMHBED CONTRACT |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_LMHBED CONTRACT |plan_COMMERCIAL standard_charge|payer_LMHBED CONTRACT |plan_COMMERCIAL |methodology additional_payer_notes |payer_LMHBED CONTRACT |plan_COMMERCIAL standard_charge|payer_MAGELLAN |plan_HMO/PPO|negotiated_dollar standard_charge|payer_MAGELLAN |plan_HMO/PPO |negotiated_percentage standard_charge|payer_MAGELLAN |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_MAGELLAN |plan_HMO/PPO standard_charge|payer_MAGELLAN |plan_HMO/PPO|methodology additional_payer_notes |payer_MAGELLAN |plan_HMO/PPO standard_charge|payer_MAGELLAN |plan_MANAGED MEDICAID|negotiated_dollar standard_charge|payer_MAGELLAN |plan_MANAGED MEDICAID |negotiated_percentage standard_charge|payer_MAGELLAN |plan_MANAGED MEDICAID|negotiated_algorithm estimated_amount|payer_MAGELLAN |plan_MANAGED MEDICAID standard_charge|payer_MAGELLAN |plan_MANAGED MEDICAID|methodology additional_payer_notes |payer_MAGELLAN |plan_MANAGED MEDICAID standard_charge|payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID|negotiated_dollar standard_charge|payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID |negotiated_percentage standard_charge|payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID|negotiated_algorithm estimated_amount|payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID standard_charge|payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID |methodology additional_payer_notes |payer_MAGELLAN COMP CARE MCD |plan_MANAGED MEDICAID standard_charge|payer_MAGELLAN HMO |plan_HMO/PPO|negotiated_dollar standard_charge|payer_MAGELLAN HMO |plan_HMO/PPO |negotiated_percentage standard_charge|payer_MAGELLAN HMO |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_MAGELLAN HMO |plan_HMO/PPO standard_charge|payer_MAGELLAN HMO |plan_HMO/PPO |methodology additional_payer_notes |payer_MAGELLAN HMO |plan_HMO/PPO standard_charge|payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE standard_charge|payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_MAGELLAN MCR HMO |plan_MANAGED MEDICARE standard_charge|payer_MEDICARE |plan_MEDICARE|negotiated_dollar standard_charge|payer_MEDICARE |plan_MEDICARE|negotiated_percentage standard_charge|payer_MEDICARE |plan_MEDICARE|negotiated_algorithm estimated_amount|payer_MEDICARE |plan_MEDICARE standard_charge|payer_MEDICARE |plan_MEDICARE |methodology additional_payer_notes |payer_MEDICARE |plan_MEDICARE standard_charge|payer_MERITAIN HEALTH AETNA |plan_HMO/PPO|negotiated_dollar standard_charge|payer_MERITAIN HEALTH AETNA |plan_HMO/PPO |negotiated_percentage standard_charge|payer_MERITAIN HEALTH AETNA |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_MERITAIN HEALTH AETNA |plan_HMO/PPO standard_charge|payer_MERITAIN HEALTH AETNA |plan_HMO/PPO |methodology additional_payer_notes |payer_MERITAIN HEALTH AETNA |plan_HMO/PPO standard_charge|payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE standard_charge|payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_MMM HEALTHCARE LLC |plan_MANAGED MEDICARE standard_charge|payer_MOLINA HEALTHCARE OF FL |plan_MANAGED MEDICAID|negotiated_dollar 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standard_charge|payer_PHILADELPHIA LIFE INS |plan_COMMERCIAL |methodology additional_payer_notes |payer_PHILADELPHIA LIFE INS |plan_COMMERCIAL standard_charge|payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL standard_charge|payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL |methodology additional_payer_notes |payer_PRIORITY HEALTH PLAN |plan_COMMERCIAL standard_charge|payer_SEMINOLE TRIBE OF FL |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_SEMINOLE TRIBE OF FL |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_SEMINOLE TRIBE OF FL |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_SEMINOLE TRIBE OF FL |plan_COMMERCIAL standard_charge|payer_SEMINOLE TRIBE OF FL |plan_COMMERCIAL |methodology additional_payer_notes 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|plan_HMO/PPO standard_charge|payer_UBH FLONEX |plan_HMO/PPO|negotiated_dollar standard_charge|payer_UBH FLONEX |plan_HMO/PPO |negotiated_percentage standard_charge|payer_UBH FLONEX |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_UBH FLONEX |plan_HMO/PPO standard_charge|payer_UBH FLONEX |plan_HMO/PPO |methodology additional_payer_notes |payer_UBH FLONEX |plan_HMO/PPO standard_charge|payer_UBH MEDICARE |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_UBH MEDICARE |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_UBH MEDICARE |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_UBH MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_UBH MEDICARE |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_UBH MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_UBH STUDENT RESOURCES |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_UBH STUDENT RESOURCES |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_UBH STUDENT RESOURCES |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_UBH STUDENT RESOURCES |plan_COMMERCIAL standard_charge|payer_UBH STUDENT RESOURCES |plan_COMMERCIAL |methodology additional_payer_notes |payer_UBH STUDENT RESOURCES |plan_COMMERCIAL standard_charge|payer_UBH/OPTUM |plan_HMO/PPO|negotiated_dollar standard_charge|payer_UBH/OPTUM |plan_HMO/PPO |negotiated_percentage standard_charge|payer_UBH/OPTUM |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_UBH/OPTUM |plan_HMO/PPO standard_charge|payer_UBH/OPTUM |plan_HMO/PPO |methodology additional_payer_notes |payer_UBH/OPTUM |plan_HMO/PPO standard_charge|payer_UHC SHARED SERVICES |plan_HMO/PPO|negotiated_dollar standard_charge|payer_UHC SHARED SERVICES |plan_HMO/PPO |negotiated_percentage standard_charge|payer_UHC SHARED SERVICES |plan_HMO/PPO|negotiated_algorithm estimated_amount|payer_UHC SHARED SERVICES |plan_HMO/PPO standard_charge|payer_UHC SHARED SERVICES |plan_HMO/PPO |methodology additional_payer_notes 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|plan_MEDICAID: OUT OF STATE|negotiated_dollar standard_charge|payer_VIRGINIA CARDINAL CARE |plan_MEDICAID: OUT OF STATE |negotiated_percentage standard_charge|payer_VIRGINIA CARDINAL CARE |plan_MEDICAID: OUT OF STATE|negotiated_algorithm estimated_amount|payer_VIRGINIA CARDINAL CARE |plan_MEDICAID: OUT OF STATE standard_charge|payer_VIRGINIA CARDINAL CARE |plan_MEDICAID: OUT OF STATE |methodology additional_payer_notes |payer_VIRGINIA CARDINAL CARE |plan_MEDICAID: OUT OF STATE standard_charge|payer_VIVA MEDICARE |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_VIVA MEDICARE |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_VIVA MEDICARE |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_VIVA MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_VIVA MEDICARE |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_VIVA MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_VIVIDA HEALTH |plan_MANAGED MEDICAID|negotiated_dollar standard_charge|payer_VIVIDA HEALTH |plan_MANAGED MEDICAID |negotiated_percentage standard_charge|payer_VIVIDA HEALTH |plan_MANAGED MEDICAID|negotiated_algorithm estimated_amount|payer_VIVIDA HEALTH |plan_MANAGED MEDICAID standard_charge|payer_VIVIDA HEALTH |plan_MANAGED MEDICAID |methodology additional_payer_notes |payer_VIVIDA HEALTH |plan_MANAGED MEDICAID standard_charge|payer_WEBTPA |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_WEBTPA |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_WEBTPA |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_WEBTPA |plan_COMMERCIAL standard_charge|payer_WEBTPA |plan_COMMERCIAL |methodology additional_payer_notes |payer_WEBTPA |plan_COMMERCIAL standard_charge|payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_WELLCARE MEDICARE |plan_MANAGED MEDICARE standard_charge|payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID|negotiated_dollar standard_charge|payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID |negotiated_percentage standard_charge|payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID|negotiated_algorithm estimated_amount|payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID standard_charge|payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID |methodology additional_payer_notes |payer_WELLCARE STAYWELL |plan_MANAGED MEDICAID standard_charge|payer_WELLPATH |plan_MANAGED MEDICARE|negotiated_dollar standard_charge|payer_WELLPATH |plan_MANAGED MEDICARE |negotiated_percentage standard_charge|payer_WELLPATH |plan_MANAGED MEDICARE|negotiated_algorithm estimated_amount|payer_WELLPATH |plan_MANAGED MEDICARE standard_charge|payer_WELLPATH |plan_MANAGED MEDICARE |methodology additional_payer_notes |payer_WELLPATH |plan_MANAGED MEDICARE standard_charge|payer_ZELIS |plan_COMMERCIAL|negotiated_dollar standard_charge|payer_ZELIS |plan_COMMERCIAL |negotiated_percentage standard_charge|payer_ZELIS |plan_COMMERCIAL|negotiated_algorithm estimated_amount|payer_ZELIS |plan_COMMERCIAL standard_charge|payer_ZELIS |plan_COMMERCIAL |methodology additional_payer_notes |payer_ZELIS |plan_COMMERCIAL standard_charge|min standard_charge |max additional_generic_notes ROOM AND BOARD GERIATRIC 3B 124 RC inpatient 2400 750 2400 per diem 875 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 1087 per diem 1360 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1110.18 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 1025 per diem 1025 per diem 875 per diem 996 per diem 1025 per diem 1025 per diem 1025 per diem 909 per diem 2400 per diem 1025 per diem 763 per diem 875 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 700 per diem 2400 per diem 2400 per diem 565 2400 ROOM AND BOARD PSYCH ADULT 2A 124 RC inpatient 2400 750 2400 per diem 875 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 1087 per diem 1360 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1110.18 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 1025 per diem 1025 per diem 875 per diem 996 per diem 1025 per diem 1025 per diem 1025 per diem 909 per diem 2400 per diem 1025 per diem 763 per diem 875 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 700 per diem 2400 per diem 2400 per diem 565 2400 ROOM AND BOARD DETOX 2B 126 RC inpatient 2400 750 2400 per diem 825 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1200 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 905 per diem 905 per diem 825 per diem 875 per diem 905 per diem 905 per diem 905 per diem 909 per diem 2400 per diem 905 per diem 763 per diem 825 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 600 per diem 2400 per diem 2400 per diem 565 2400 ROOM AND BOARD GERIATRIC DETOX 126 RC inpatient 2400 750 2400 per diem 825 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1200 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 905 per diem 905 per diem 825 per diem 875 per diem 905 per diem 905 per diem 905 per diem 909 per diem 2400 per diem 905 per diem 763 per diem 825 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 600 per diem 2400 per diem 2400 per diem 565 2400 CD/REHAB ADULT 3A 128 RC inpatient 2400 750 825 per diem 825 per diem 1050 per diem 950 per diem 800 per diem 825 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 1110.18 per diem 909 per diem 909 per diem 2400 per diem 500 per diem 2400 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 825 per diem 2400 per diem 800 per diem 909 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 770 per diem 770 per diem 825 per diem 742 per diem 770 per diem 770 per diem 770 per diem 909 per diem 770 per diem 763 per diem 825 per diem 909 per diem 909 per diem 600 per diem 2400 per diem 500 2400 ELECTOCONVULSIVE THERAPY - INPATIENT ANC 901 RC both 1650 500 1650 per diem 610 per diem 625 per diem 550 per diem 550 per diem 500 per diem 625 per diem 625 per diem 1650 per diem 1650 per diem 665 per diem 665 per diem 3300 per diem 3300 per diem 662 per diem 662 per diem 662 per diem 662 per diem 657 per diem 1122 per diem 561 per diem 630 per diem 1780 per diem 2380 per diem 3300 per diem 1650 per diem 1650 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 561 per diem 1650 per diem 660 per diem 3300 per diem 1650 per diem 1650 per diem 1650 per diem 561 per diem 1122 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 1650 per diem 1650 per diem 500 per diem 500 per diem 3300 per diem 3300 per diem 1650 per diem 3300 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 454.69 per diem 625 per diem 1650 per diem 561 per diem 561 per diem 3300 per diem 3300 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 3300 per diem 561 per diem 561 per diem 561 per diem 525 per diem 1650 per diem 385.08 per diem 1650 per diem 3300 per diem 610 per diem 610 per diem 610 per diem 578 per diem 610 per diem 610 per diem 610 per diem 561 per diem 3300 per diem 610 per diem 570 per diem 610 per diem 1650 per diem 1650 per diem 561 per diem 1650 per diem 1650 per diem 561 per diem 525 per diem 500 per diem 500 per diem 1650 per diem 1650 per diem 385.08 3300 ELECTOCONVULSIVE THERAPY OUTPATIENT 901 RC both 1650 500 1650 per diem 610 per diem 625 per diem 550 per diem 550 per diem 500 per diem 625 per diem 625 per diem 1650 per diem 1650 per diem 665 per diem 665 per diem 3300 per diem 3300 per diem 662 per diem 662 per diem 662 per diem 662 per diem 657 per diem 1122 per diem 561 per diem 630 per diem 1780 per diem 2380 per diem 3300 per diem 1650 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 561 per diem 1650 per diem 660 per diem 3300 per diem 1650 per diem 1650 per diem 1650 per diem 561 per diem 1122 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 1650 per diem 1650 per diem 500 per diem 500 per diem 3300 per diem 3300 per diem 1650 per diem 3300 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 454.69 per diem 625 per diem 1650 per diem 561 per diem 561 per diem 3300 per diem 3300 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 3300 per diem 561 per diem 561 per diem 561 per diem 525 per diem 1650 per diem 385.08 per diem 1650 per diem 3300 per diem 610 per diem 610 per diem 610 per diem 578 per diem 610 per diem 610 per diem 610 per diem 561 per diem 3300 per diem 610 per diem 570 per diem 610 per diem 1650 per diem 1650 per diem 561 per diem 1650 per diem 1650 per diem 561 per diem 525 per diem 500 per diem 500 per diem 1650 per diem 1650 per diem 385.08 3300 INTENSIVE OUTPATIENT PROGRAM MH PROGRAM 905 RC outpatient 540 200 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem 150 540 INTENSIVE OUTPATIENT PROGRAM PROGRAM TH 905 RC outpatient 540 200 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem 150 540 INTENSIVE OUTPATIENT PROGRAM PSYCH ADOLESCENT 905 RC outpatient 540 200 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem 150 540 INTENSIVE OUTPATIENT PROGRAM S.A PROGRAM 906 RC outpatient 540 200 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 326 per diem 359 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem 150 540 PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC outpatient 875 350 430 per diem 320 per diem 425 per diem 425 per diem 400 per diem 320 per diem 320 per diem 320 per diem 320 per diem 875 per diem 875 per diem 425 per diem 425 per diem 425 per diem 425 per diem 435 per diem 399 per diem 399.3 per diem 375 per diem 408 per diem 469 per diem 875 per diem 875 per diem 375 per diem 375 per diem 375 per diem 375 per diem 375 per diem 399.33 per diem 529.79 per diem 875 per diem 399.33 per diem 399.33 per diem 875 per diem 875 per diem 875 per diem 350 per diem 350 per diem 875 per diem 875 per diem 875 per diem 875 per diem 285 per diem 285 per diem 285 per diem 252.77 per diem 320 per diem 399.33 per diem 399.33 per diem 875 per diem 875 per diem 875 per diem 875 per diem 875 per diem 399 per diem 399.33 per diem 399.33 per diem 300 per diem 438 per diem 875 per diem 875 per diem 440 per diem 440 per diem 430 per diem 415 per diem 440 per diem 440 per diem 440 per diem 875 per diem 440 per diem 377 per diem 430 per diem 875 per diem 875 per diem 399.33 per diem 399.33 per diem 875 per diem 275 per diem 275 per diem 252.77 875